van Nimwegen Sebastiaan A, Van Goethem Bart, de Gier Jeffrey, Kirpensteijn Jolle
Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584CM, Utrecht, the Netherlands.
Department of Small Animal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium.
BMC Vet Res. 2018 Nov 7;14(1):333. doi: 10.1186/s12917-018-1658-y.
Surgical treatment of ovarian remnant syndrome (ORS) in dogs usually necessitates large celiotomies and considerable manipulation of organs because of the relatively deep position of ovarian remnant tissue, large patient size, and often encountered adhesions. In women, laparoscopic treatment of ORS is successful and has significant advantages over laparotomy. Since laparoscopic ovariectomy has significant advantages over open ovariectomy in dogs, including reduced surgical stress and postoperative pain and shorter convalescence period, the rationale for a laparoscopic approach of canine ORS is evident. Feasibility and efficacy of a laparoscopic approach for treatment of ORS in dogs was prospectively evaluated using a standardized protocol for diagnosis, treatment, and follow-up. Treatment success was evaluated by histology of removed tissues, postoperative hormone testing, and long-term clinical follow-up.
Thirty-two client-owned predominantly medium and large breed dogs diagnosed with ORS underwent abdominal ultrasound for ovarian remnant localization prior to laparoscopic surgery for removal of ovarian remnants. Tissue dissection and excision was performed using a vessel sealing forceps. Laparoscopy subjectively enabled detailed visibility and facilitated detection and removal of suspected ovarian tissue in all cases. Histology confirmed ovarian origin of removed tissue in all dogs. Additionally, a GnRH stimulation test was performed in fourteen dogs after a median follow-up of 10.5 months, which verified absence of residual functional ovarian remnant tissue in all dogs. Median surgery duration was 97.5 min and mean total convalescence duration, subjectively scored by owners, was 1.5 ± 0.7 days. No major complications occurred. Adhesions were observed in 79% of the dogs, complicated the surgical approach, and significantly affected surgery duration (85 versus 109 min; p = 0.03). Minor hemorrhage occurred in 12% and significantly increased surgery duration (95.5 versus 128 min; p = 0.02). Trendelenburg position and lateral tilting of the patient were essential for proper access to ovarian remnants. GnRH stimulation test results and/or absence of clinical signs indicative of ORS after a median follow-up period of 22.5 months confirmed treatment efficacy in all dogs.
Laparoscopic surgery for ORS in dogs is effective with minimal complications and short convalescence and can successfully replace the conventional, more invasive open surgical procedure.
由于卵巢残留组织位置相对较深、病犬体型较大且常伴有粘连，犬卵巢残留综合征（ORS）的手术治疗通常需要进行大型剖腹手术并对器官进行大量操作。在人类中，ORS的腹腔镜治疗是成功的，且相较于剖腹手术具有显著优势。由于腹腔镜卵巢切除术相较于开放性卵巢切除术在犬类中具有显著优势，包括减轻手术应激和术后疼痛以及缩短恢复期，因此采用腹腔镜方法治疗犬ORS的理论依据是显而易见的。本研究采用标准化的诊断、治疗及随访方案，前瞻性评估了腹腔镜治疗犬ORS的可行性和疗效。通过对切除组织进行组织学检查、术后激素检测以及长期临床随访来评估治疗效果。
32只主要为中大型品种的客户拥有犬被诊断为ORS，在进行腹腔镜手术切除卵巢残留之前，先接受腹部超声检查以定位卵巢残留。使用血管闭合钳进行组织分离和切除。腹腔镜检查在所有病例中均能主观地提供详细视野，便于检测和切除可疑的卵巢组织。组织学检查证实所有犬切除组织均来源于卵巢。此外，在中位随访10.5个月后，对14只犬进行了GnRH刺激试验，证实所有犬均无残留的功能性卵巢残留组织。中位手术时间为97.5分钟，主人主观评分的平均总恢复期为1.5±0.7天。未发生重大并发症。79%的犬观察到粘连，这使手术操作变得复杂，并显著影响手术时间（85分钟对109分钟；p = 0.03）。12%的犬发生轻微出血，显著延长了手术时间（95.5分钟对128分钟；p = 0.02）。特伦德伦伯格体位和病犬的侧倾对于正确暴露卵巢残留至关重要。中位随访22.5个月后，GnRH刺激试验结果和/或无ORS临床症状表明所有犬的治疗均有效。
犬ORS的腹腔镜手术疗效显著，并发症少，恢复期短，可以成功替代传统的、创伤性更大的开放性手术。
